Child and Adolescent Psychiatric Clinics of North America, Apr 1, 2019
In traditional medical practice, the diagnostic interview is focused on symptom collection, diagn... more In traditional medical practice, the diagnostic interview is focused on symptom collection, diagnosis, and treatment. The psychiatric interview is based on the medical model, but mental health clinicians lack the tests found in general medicine. Rapport is the most essential tool for the psychiatrist to uncover symptoms and develop a diagnosis and treatment plan. This article brings a scientific lens to the psychiatric interview. Under this microscope the value of eliciting the patient's well-being at the outset of the interview becomes clear. Using positive psychology, an evidenced-based rationale for the positive assessment is outlined and methodology and practice of the assessment reviewed.
Child and Adolescent Psychiatric Clinics of North America, 2019
In traditional medical practice, the diagnostic interview is focused on symptom collection, diagn... more In traditional medical practice, the diagnostic interview is focused on symptom collection, diagnosis, and treatment. The psychiatric interview is based on the medical model, but mental health clinicians lack the tests found in general medicine. Rapport is the most essential tool for the psychiatrist to uncover symptoms and develop a diagnosis and treatment plan. This article brings a scientific lens to the psychiatric interview. Under this microscope the value of eliciting the patient's well-being at the outset of the interview becomes clear. Using positive psychology, an evidenced-based rationale for the positive assessment is outlined and methodology and practice of the assessment reviewed.
Screening for social determinants of health allows health care teams to assess and address social... more Screening for social determinants of health allows health care teams to assess and address social factors that influence one's health, mental health, and access to care. These social factors include poverty, health literacy, social support, exposure to trauma, food insecurity, and housing instability. The objective of this study was to examine what screening tools for social determinants of health are being used, in what contexts, and with what populations. Findings suggest that health literacy is the most commonly screened for, followed by trauma history, social support, food insecurity and housing across diverse contexts and populations. Results from this study can be used to inform providers of available screening tools and resources that can be readily utilized in practice.
This article presents findings from a survey of undergraduate social work (Bachelor of Social Wor... more This article presents findings from a survey of undergraduate social work (Bachelor of Social Work [BSW]) students about their experiences with remote learning during the 2020 COVID-19 pandemic. In response to this crisis, remote learning was rapidly implemented and many BSW educators and students experienced online classrooms for the first time. Findings from this study shed light on how remote learning shapes the interpersonal relationships and communication that are so critical to building students’ sense of classroom belonging, engagement, and learning.
Journal of Emotional and Behavioral Disorders, 2017
Disproportionately high rates of caregiver stress and depression are found among poverty-impacted... more Disproportionately high rates of caregiver stress and depression are found among poverty-impacted communities, with high levels of caregiver stress and depression putting youth at heightened risk for the onset and perpetuation of disruptive behavior disorders. The purpose of this study was to examine the effects of a behavioral parent training program called the 4Rs and 2Ss for Strengthening Families Program (4R2S) on caregiver stress and depressive symptoms among 320 youth aged 7 to 11 and their families assigned to either the 4R2S or services as usual (SAU) condition. Among caregivers with clinically significant (CS) scores at baseline, 4R2S participants manifested significantly reduced scores on the stress and depressive symptom scores to SAU participants at 6-month follow-up. Findings suggest that 4R2S may reduce caregiver stress and depressive symptoms among those caregivers initially manifesting CS levels of stress or depressive symptoms.
The Affordable Care Act aims to increase affordable coverage, reduce overall costs, and improve h... more The Affordable Care Act aims to increase affordable coverage, reduce overall costs, and improve health outcomes. To achieve these aims, new knowledge and skills must be built within the existing workforce. The purpose of this article is to examine the behavioral and organizational changes brought about by an educational program that aimed to retool the healthcare workforce for the implementation of integrated primary and behavioral healthcare models, with an added emphasis on prevention. Sixty-three participants of an Advanced Certificate Program completed 1 or more evidence-informed learning modules centered on integrated primary and behavioral health care. The vast majority of students who completed each of the 5 modules of the program reported acquiring new knowledge and skills. Student satisfaction of the program met or exceeded overall expectations. In addition, program participation has resulted in not only students' intentions to change workplace practices but also actual implementation of workplace changes related to integrated care models. The Advanced Certificate Program appears to be a promising platform for service providers to align their knowledge and skills with the premises of current healthcare reform.
Journal of burn care & research : official publication of the American Burn Association, Jan 18, 2018
Recovery of burn patients may be impeded by mental health problems. By gaining a better understan... more Recovery of burn patients may be impeded by mental health problems. By gaining a better understanding of the impact that psychological factors may have on hospital length of stay, providers may be better informed to address the complex needs of burn survivors through effective and efficient practices. This systematic review summarizes existing data on the adverse psychological factors for the length of burn patients' hospitalization, and assesses the methodological quality of the extant literature on mental health conditions of burn survivors. A literature search was conducted in four electronic databases: PubMed, PsychINFO, Science Direct, and the Cumulative Index to Nursing and Allied Health Literature. Results yielded reports published between 1980 and 2016. Methodological quality was assessed by using an 11-item MQS system. 74 studies were identified by search; nineteen articles were eligible for analysis. Findings demonstrate paucity of evidence in the area. Reports indicat...
Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditi... more Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention.
The purpose of this commentary was to describe the barriers and facilitators to mental health scr... more The purpose of this commentary was to describe the barriers and facilitators to mental health screening efforts for children between age 5 and 18 years within three primary care clinics in poverty-impacted communities as part of an integrated care model. Three screeners, two women and one male, participated in a screening effort between September and December 2015. Screeners were interviewed about their perceptions of barriers and facilitators to screening. Organizational, family, and screener-level factors were found to influence delivery of screenings to children. Given the benefits of screening in primary care settings, identifying barriers to these initiatives and ways to address them pre-emptively could potentially alter the developmental trajectory and outcomes of children at risk for serious mental health conditions.
This article presents findings from a survey of undergraduate social work (Bachelor of Social Wor... more This article presents findings from a survey of undergraduate social work (Bachelor of Social Work [BSW]) students about their experiences with remote learning during the 2020 COVID-19 pandemic. In response to this crisis, remote learning was rapidly implemented and many BSW educators and students experienced online classrooms for the first time. Findings from this study shed light on how remote learning shapes the interpersonal relationships and communication that are so critical to building students’ sense of classroom belonging, engagement, and learning.
Objective
Guided by the Transactional Model of Stress and Coping, this study seeks to (1) examine... more Objective Guided by the Transactional Model of Stress and Coping, this study seeks to (1) examine the independent relationships between the level of distress among burn survivors, pre-morbid psychiatric history, and burn severity on length of hospital stay, and (2) to examine the relationship between having a premorbid psychiatric history and level of distress following a burn injury.
Methods Data collected by the National Institute on Disability, Independent Living, Rehabilitation Research funded Burn Model System (N = 846) was used to theoretically link psychological distress with the length of hospital stay for survivors of burn injuries. Structural Equation Modeling was used to evaluate the aims of this study.
Results Although counterintuitive, and while significant, burn severity was found to have a rather modest association with a burn survivor’s level of distress, indicating that one’s ability to cope may be a better predictor of distress rather than burn severity alone. Premorbid psychiatric history was significantly associated with increased levels of distress. While burn severity was associated with length of stay, level of distress did not act as a partial mediator. Length of stay was, however, significantly related to having a premorbid-psychiatric history. Of notable interest, a significant racial, ethnic, and gender difference exists in level of distress. Women and people of color experience higher levels of distress holding constant burn severity and psychiatric history.
Conclusion A need exists to assess for and address premorbid and current mental health challenges of burn survivors, specifically the ability to cope, especially among people of color and women, regardless of the burn size or severity.
Screening for social determinants of health allows health care teams to assess and address social... more Screening for social determinants of health allows health care teams to assess and address social factors that influence one’s health, mental health, and access to care. These social factors include poverty, health literacy, social support, exposure to trauma, food insecurity, and housing instability. The objective of this study was to examine what screening tools for social determinants of health are being used, in what contexts, and with what populations. Findings suggest that health literacy is the most commonly screened for, followed by trauma history, social support, food insecurity and housing across diverse contexts and populations. Results from this study can be used to inform providers of available screening tools and resources that can be readily utilized in practice.
Child and Adolescent Psychiatric Clinics of North America, 2019
The traditional psychiatric interview that has been used for the past 80 years is based on the me... more The traditional psychiatric interview that has been used for the past 80 years is based on the medical model and has no evidence base to support that its structure encourages rapport, diagnosis, or treatment. Negative and positive emotions have different purposes. Eliciting positive emotions encourages trust, compromise, and many other qualities that are ideal for developing rapport with the patient. The current psychiatric interview proceeds directly to assessing the negative emotions of a patient, but a positive assessment would begin with a study of the patient’s strengths and then proceed to understanding the patient’s challenges. By assessing the strengths of a patient, the clinician may elicit positive emotions from the caregiver and patient, which facilitates rapport, diagnosis, and treatment. The diagnostic interview should be modified and vigorously tested to ensure that it is ideally suited for helping develop rapport, eliciting symptoms, and aiding in diagnosis and treatment.
Recovery of burn patients may be impeded by mental health problems. By gaining a better understan... more Recovery of burn patients may be impeded by mental health problems. By gaining a better understanding of the impact that psychological factors may have on hospital length of stay, providers may be better informed to address the complex needs of burn survivors through effective and efficient practices. This systematic review summarizes existing data on the adverse psychological factors for the length of burn patients’ hospitalization, and assesses the methodological quality of the extant literature on mental health conditions of burn survivors. A literature search was conducted in four electronic databases: PubMed, PsychINFO, Science Direct, and the Cumulative Index to Nursing and Allied Health Literature. Results yielded reports published between 1980 and 2016. Methodological quality was assessed by using an 11-item methodological quality score system. Seventy-four studies were identified by search; 19 articles were eligible for analysis. Findings demonstrate paucity of evidence in the area. Reports indicate longer hospital stay among burn patients with mental health problems. Substance use was the most consistent mental-health predictor of longer hospital stay. Heterogeneity in data on mental health conditions rendered impossible estimation of effect sizes of individual psychological factors on length of hospitalization. Many studies over-relied on retrospective designs, and crude indicators of psychological factors. Findings indicate that mental health problems do have an impact on the trajectory of burn recovery by increasing the length of hospital stay for burn survivors. Inpatient mental health services for burn patients are critically needed. Prospective designs, and more sensitive psychological indicators are needed for future studies.
Child and Adolescent Psychiatric Clinics of North America, Apr 1, 2019
In traditional medical practice, the diagnostic interview is focused on symptom collection, diagn... more In traditional medical practice, the diagnostic interview is focused on symptom collection, diagnosis, and treatment. The psychiatric interview is based on the medical model, but mental health clinicians lack the tests found in general medicine. Rapport is the most essential tool for the psychiatrist to uncover symptoms and develop a diagnosis and treatment plan. This article brings a scientific lens to the psychiatric interview. Under this microscope the value of eliciting the patient's well-being at the outset of the interview becomes clear. Using positive psychology, an evidenced-based rationale for the positive assessment is outlined and methodology and practice of the assessment reviewed.
Child and Adolescent Psychiatric Clinics of North America, 2019
In traditional medical practice, the diagnostic interview is focused on symptom collection, diagn... more In traditional medical practice, the diagnostic interview is focused on symptom collection, diagnosis, and treatment. The psychiatric interview is based on the medical model, but mental health clinicians lack the tests found in general medicine. Rapport is the most essential tool for the psychiatrist to uncover symptoms and develop a diagnosis and treatment plan. This article brings a scientific lens to the psychiatric interview. Under this microscope the value of eliciting the patient's well-being at the outset of the interview becomes clear. Using positive psychology, an evidenced-based rationale for the positive assessment is outlined and methodology and practice of the assessment reviewed.
Screening for social determinants of health allows health care teams to assess and address social... more Screening for social determinants of health allows health care teams to assess and address social factors that influence one's health, mental health, and access to care. These social factors include poverty, health literacy, social support, exposure to trauma, food insecurity, and housing instability. The objective of this study was to examine what screening tools for social determinants of health are being used, in what contexts, and with what populations. Findings suggest that health literacy is the most commonly screened for, followed by trauma history, social support, food insecurity and housing across diverse contexts and populations. Results from this study can be used to inform providers of available screening tools and resources that can be readily utilized in practice.
This article presents findings from a survey of undergraduate social work (Bachelor of Social Wor... more This article presents findings from a survey of undergraduate social work (Bachelor of Social Work [BSW]) students about their experiences with remote learning during the 2020 COVID-19 pandemic. In response to this crisis, remote learning was rapidly implemented and many BSW educators and students experienced online classrooms for the first time. Findings from this study shed light on how remote learning shapes the interpersonal relationships and communication that are so critical to building students’ sense of classroom belonging, engagement, and learning.
Journal of Emotional and Behavioral Disorders, 2017
Disproportionately high rates of caregiver stress and depression are found among poverty-impacted... more Disproportionately high rates of caregiver stress and depression are found among poverty-impacted communities, with high levels of caregiver stress and depression putting youth at heightened risk for the onset and perpetuation of disruptive behavior disorders. The purpose of this study was to examine the effects of a behavioral parent training program called the 4Rs and 2Ss for Strengthening Families Program (4R2S) on caregiver stress and depressive symptoms among 320 youth aged 7 to 11 and their families assigned to either the 4R2S or services as usual (SAU) condition. Among caregivers with clinically significant (CS) scores at baseline, 4R2S participants manifested significantly reduced scores on the stress and depressive symptom scores to SAU participants at 6-month follow-up. Findings suggest that 4R2S may reduce caregiver stress and depressive symptoms among those caregivers initially manifesting CS levels of stress or depressive symptoms.
The Affordable Care Act aims to increase affordable coverage, reduce overall costs, and improve h... more The Affordable Care Act aims to increase affordable coverage, reduce overall costs, and improve health outcomes. To achieve these aims, new knowledge and skills must be built within the existing workforce. The purpose of this article is to examine the behavioral and organizational changes brought about by an educational program that aimed to retool the healthcare workforce for the implementation of integrated primary and behavioral healthcare models, with an added emphasis on prevention. Sixty-three participants of an Advanced Certificate Program completed 1 or more evidence-informed learning modules centered on integrated primary and behavioral health care. The vast majority of students who completed each of the 5 modules of the program reported acquiring new knowledge and skills. Student satisfaction of the program met or exceeded overall expectations. In addition, program participation has resulted in not only students' intentions to change workplace practices but also actual implementation of workplace changes related to integrated care models. The Advanced Certificate Program appears to be a promising platform for service providers to align their knowledge and skills with the premises of current healthcare reform.
Journal of burn care & research : official publication of the American Burn Association, Jan 18, 2018
Recovery of burn patients may be impeded by mental health problems. By gaining a better understan... more Recovery of burn patients may be impeded by mental health problems. By gaining a better understanding of the impact that psychological factors may have on hospital length of stay, providers may be better informed to address the complex needs of burn survivors through effective and efficient practices. This systematic review summarizes existing data on the adverse psychological factors for the length of burn patients' hospitalization, and assesses the methodological quality of the extant literature on mental health conditions of burn survivors. A literature search was conducted in four electronic databases: PubMed, PsychINFO, Science Direct, and the Cumulative Index to Nursing and Allied Health Literature. Results yielded reports published between 1980 and 2016. Methodological quality was assessed by using an 11-item MQS system. 74 studies were identified by search; nineteen articles were eligible for analysis. Findings demonstrate paucity of evidence in the area. Reports indicat...
Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditi... more Disruptive behavior disorders (DBDs) are chronic, impairing, and costly behavioral health conditions that are four times more prevalent among children of color living in impoverished communities as compared to the general population. This disparity is largely due to the increased exposure to stressors related to low socioeconomic status including community violence, unstable housing, under supported schools, substance abuse, and limited support systems. However, despite high rates and greater need, there is a considerably lower rate of mental health service utilization among these youth. Accordingly, the current study aims to describe a unique model of integrated health care for ethnically diverse youth living in a New York City borough. With an emphasis on addressing possible barriers to implementation, integrated models for children have the potential to prevent ongoing mental health problems through early detection and intervention.
The purpose of this commentary was to describe the barriers and facilitators to mental health scr... more The purpose of this commentary was to describe the barriers and facilitators to mental health screening efforts for children between age 5 and 18 years within three primary care clinics in poverty-impacted communities as part of an integrated care model. Three screeners, two women and one male, participated in a screening effort between September and December 2015. Screeners were interviewed about their perceptions of barriers and facilitators to screening. Organizational, family, and screener-level factors were found to influence delivery of screenings to children. Given the benefits of screening in primary care settings, identifying barriers to these initiatives and ways to address them pre-emptively could potentially alter the developmental trajectory and outcomes of children at risk for serious mental health conditions.
This article presents findings from a survey of undergraduate social work (Bachelor of Social Wor... more This article presents findings from a survey of undergraduate social work (Bachelor of Social Work [BSW]) students about their experiences with remote learning during the 2020 COVID-19 pandemic. In response to this crisis, remote learning was rapidly implemented and many BSW educators and students experienced online classrooms for the first time. Findings from this study shed light on how remote learning shapes the interpersonal relationships and communication that are so critical to building students’ sense of classroom belonging, engagement, and learning.
Objective
Guided by the Transactional Model of Stress and Coping, this study seeks to (1) examine... more Objective Guided by the Transactional Model of Stress and Coping, this study seeks to (1) examine the independent relationships between the level of distress among burn survivors, pre-morbid psychiatric history, and burn severity on length of hospital stay, and (2) to examine the relationship between having a premorbid psychiatric history and level of distress following a burn injury.
Methods Data collected by the National Institute on Disability, Independent Living, Rehabilitation Research funded Burn Model System (N = 846) was used to theoretically link psychological distress with the length of hospital stay for survivors of burn injuries. Structural Equation Modeling was used to evaluate the aims of this study.
Results Although counterintuitive, and while significant, burn severity was found to have a rather modest association with a burn survivor’s level of distress, indicating that one’s ability to cope may be a better predictor of distress rather than burn severity alone. Premorbid psychiatric history was significantly associated with increased levels of distress. While burn severity was associated with length of stay, level of distress did not act as a partial mediator. Length of stay was, however, significantly related to having a premorbid-psychiatric history. Of notable interest, a significant racial, ethnic, and gender difference exists in level of distress. Women and people of color experience higher levels of distress holding constant burn severity and psychiatric history.
Conclusion A need exists to assess for and address premorbid and current mental health challenges of burn survivors, specifically the ability to cope, especially among people of color and women, regardless of the burn size or severity.
Screening for social determinants of health allows health care teams to assess and address social... more Screening for social determinants of health allows health care teams to assess and address social factors that influence one’s health, mental health, and access to care. These social factors include poverty, health literacy, social support, exposure to trauma, food insecurity, and housing instability. The objective of this study was to examine what screening tools for social determinants of health are being used, in what contexts, and with what populations. Findings suggest that health literacy is the most commonly screened for, followed by trauma history, social support, food insecurity and housing across diverse contexts and populations. Results from this study can be used to inform providers of available screening tools and resources that can be readily utilized in practice.
Child and Adolescent Psychiatric Clinics of North America, 2019
The traditional psychiatric interview that has been used for the past 80 years is based on the me... more The traditional psychiatric interview that has been used for the past 80 years is based on the medical model and has no evidence base to support that its structure encourages rapport, diagnosis, or treatment. Negative and positive emotions have different purposes. Eliciting positive emotions encourages trust, compromise, and many other qualities that are ideal for developing rapport with the patient. The current psychiatric interview proceeds directly to assessing the negative emotions of a patient, but a positive assessment would begin with a study of the patient’s strengths and then proceed to understanding the patient’s challenges. By assessing the strengths of a patient, the clinician may elicit positive emotions from the caregiver and patient, which facilitates rapport, diagnosis, and treatment. The diagnostic interview should be modified and vigorously tested to ensure that it is ideally suited for helping develop rapport, eliciting symptoms, and aiding in diagnosis and treatment.
Recovery of burn patients may be impeded by mental health problems. By gaining a better understan... more Recovery of burn patients may be impeded by mental health problems. By gaining a better understanding of the impact that psychological factors may have on hospital length of stay, providers may be better informed to address the complex needs of burn survivors through effective and efficient practices. This systematic review summarizes existing data on the adverse psychological factors for the length of burn patients’ hospitalization, and assesses the methodological quality of the extant literature on mental health conditions of burn survivors. A literature search was conducted in four electronic databases: PubMed, PsychINFO, Science Direct, and the Cumulative Index to Nursing and Allied Health Literature. Results yielded reports published between 1980 and 2016. Methodological quality was assessed by using an 11-item methodological quality score system. Seventy-four studies were identified by search; 19 articles were eligible for analysis. Findings demonstrate paucity of evidence in the area. Reports indicate longer hospital stay among burn patients with mental health problems. Substance use was the most consistent mental-health predictor of longer hospital stay. Heterogeneity in data on mental health conditions rendered impossible estimation of effect sizes of individual psychological factors on length of hospitalization. Many studies over-relied on retrospective designs, and crude indicators of psychological factors. Findings indicate that mental health problems do have an impact on the trajectory of burn recovery by increasing the length of hospital stay for burn survivors. Inpatient mental health services for burn patients are critically needed. Prospective designs, and more sensitive psychological indicators are needed for future studies.
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Papers by Kyle O'Brien
Guided by the Transactional Model of Stress and Coping, this study seeks to (1) examine the independent relationships between the level of distress among burn survivors, pre-morbid psychiatric history, and burn severity on length of hospital stay, and (2) to examine the relationship between having a premorbid psychiatric history and level of distress following a burn injury.
Methods
Data collected by the National Institute on Disability, Independent Living, Rehabilitation Research funded Burn Model System (N = 846) was used to theoretically link psychological distress with the length of hospital stay for survivors of burn injuries. Structural Equation Modeling was used to evaluate the aims of this study.
Results
Although counterintuitive, and while significant, burn severity was found to have a rather modest association with a burn survivor’s level of distress, indicating that one’s ability to cope may be a better predictor of distress rather than burn severity alone. Premorbid psychiatric history was significantly associated with increased levels of distress. While burn severity was associated with length of stay, level of distress did not act as a partial mediator. Length of stay was, however, significantly related to having a premorbid-psychiatric history. Of notable interest, a significant racial, ethnic, and gender difference exists in level of distress. Women and people of color experience higher levels of distress holding constant burn severity and psychiatric history.
Conclusion
A need exists to assess for and address premorbid and current mental health challenges of burn survivors, specifically the ability to cope, especially among people of color and women, regardless of the burn size or severity.
Guided by the Transactional Model of Stress and Coping, this study seeks to (1) examine the independent relationships between the level of distress among burn survivors, pre-morbid psychiatric history, and burn severity on length of hospital stay, and (2) to examine the relationship between having a premorbid psychiatric history and level of distress following a burn injury.
Methods
Data collected by the National Institute on Disability, Independent Living, Rehabilitation Research funded Burn Model System (N = 846) was used to theoretically link psychological distress with the length of hospital stay for survivors of burn injuries. Structural Equation Modeling was used to evaluate the aims of this study.
Results
Although counterintuitive, and while significant, burn severity was found to have a rather modest association with a burn survivor’s level of distress, indicating that one’s ability to cope may be a better predictor of distress rather than burn severity alone. Premorbid psychiatric history was significantly associated with increased levels of distress. While burn severity was associated with length of stay, level of distress did not act as a partial mediator. Length of stay was, however, significantly related to having a premorbid-psychiatric history. Of notable interest, a significant racial, ethnic, and gender difference exists in level of distress. Women and people of color experience higher levels of distress holding constant burn severity and psychiatric history.
Conclusion
A need exists to assess for and address premorbid and current mental health challenges of burn survivors, specifically the ability to cope, especially among people of color and women, regardless of the burn size or severity.